SERENITY BROADMOOR LLC NPI 1750753851

NPI Information

NPI: 1750753851
Provider Name: SERENITY BROADMOOR LLC

Doing Business As: THE BROADMOOR ALF

Classification: Assisted Living Facility - 310400000X
Entity Type: Organization

CLIA Number: 10D2203934

Address:
200 DIXIELAND DR
FORT PIERCE, FL
ZIP 34982
Phone: (772) 468-7235
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SERENITY BROADMOOR LLC is an assisted living facility in Fort Pierce, FL. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. SERENITY BROADMOOR LLC NPI is 1750753851. The provider is registered as an organization entity type.
The provider Is Doing Business As The Broadmoor Alf.

The provider's business location address is:

200 DIXIELAND DR
FORT PIERCE, FL
ZIP 34982-706
Phone: (772) 468-7235

The provider's authorized official is Lonnie Steckler .
The authorized official title is Manager and has the following contact phone number (954) 748-0509.

The CLIA number assigned to this NPI record is 10D2203934 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/28/2015 and was last updated on 10/28/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	310400000X	Assisted Living Facility		AL9190	FLORIDA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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